| NPI | 1043174618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 195104) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.006893) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2025-12-09 |
| Last Update Date | 2026-02-13 |